Objective To explore the effect of PDCA mode nursing on episiotomy rate and wound aesthetics of primipara. Methods A total of 100 primiparas who gave birth naturally in our hospital from June 2022 to June 2023 were randomly divided into control group and observation group, with 50 primiparas in each group. The control group was given routine nursing, and the observation group was given PDCA mode nursing on the basis of the control group. The perineal laceration rate, episiotomy rate, wound recovery rate, delivery situation and nursing quality score were compared between the two groups. Results The episiotomy rate of the observation group was 34.00%, which was lower than 56.00% of the control group, and the difference was statistically significant (P <0.05). The rate of perineal laceration in the observation group was lower than that in the control group, and the difference was statistically significant (P <0.05). The aesthetic rate of wound recovery in the observation group was higher than that in the control group, the difference was statistically significant (P <0.05). The total labor time and VAS score at 48 h after delivery in the observation group were better than those in the control group, and the differences were statistically significant (P <0.05). The scores of service attitude, nursing skills, wound management and communication ability in the observation group were higher than those in the control group, and the differences were statistically significant (P <0.05). Conclusion The application of PDCA model nursing for primipara is helpful to strictly control the indications of episiotomy, reduce the rate of episiotomy, and improve the aesthetic rate of wound recovery, which is worthy of clinical application.